Everyone knows the adage, “If you’ve seen one RHIO, you’ve seen one RHIO.”

“There is no RHIO in a box,” agrees Christina Thielst, COO of Ventura County Medical Center in Southern California. “Every RHIO is unique – a function of the culture and climate of the community being served.”

Despite the general acceptance that every regional health information organization is different, Thielst points out that there are basic issues every RHIO must address. That’s the gist of The Guide to Establishing a RHIO, which was written by the HIMSS RHIO Guidebook Task Force and debuted at the 2007 HIMSS Annual Conference & Exhibition in New Orleans in late February.

Thielst, who was part of the task force, wrote the chapter that addresses the big picture of managing, governing and administering a RHIO. She had wanted to write a RHIO guide back in 2004 and eventually released an electronic version in January 2006. Her goal was to advance RHIO discussion from a collaborative to a formal structure and to focus on how it could function more efficiently. Unfortunately, “nobody seemed to be interested,” she said.

Then in March 2006, HIMSS invited Thielst to join a work group of 15 to 20 people with different expertise and disciplines. The work group’s task was to design a RHIO infrastructure for those just starting out. Thielst and LeRoy Jones served as co-editors, with each task force member contributing articles based on their expertise.

“This guidebook brings out into the open the themes and common threads on how to get started,” she said.

Thielst said her chapter was heavily influenced by her experience with the Santa Barbara County Care Data Exchange, which recently stopped its health information exchange efforts in March. During her time there in 2003 and 2004, she helped find an executive director to lead the project.

Thielst covered her reaction to SBCCDE’s demise on her Web log, but she reiterated her opinion that politics and lack of communication led to its shutdown. “Leadership from all stakeholders didn’t do a good enough job in keeping the legal counsel informed and engaged,” she said. “It was a huge mistake.”

Thielst said that not all stakeholders were committed to the vision and that too much time was devoted to individual interests. Approximately $10 million was spent on legal fees and addressing federal and state privacy laws. “We had a disconnect,” she said, speaking of the national-level consultants and the local attorneys representing the local providers. “That’s where a lot of the downfall originated from,” she said.

Santa Barbara, California, is a unique community with an extremely competitive payer market. The local managed MediCal payer took a lead role, but the lack of participation by the local private insurance companies was a weakness, especially given that payers would be accruing most of the benefits.

Another weakness was the fact that SBCCDE never engaged the community and never became part of the community. “It’s vital that the community come together as a whole,” Thielst said simply. And that is at the heart of her chapter.

Overall, as the guidebook shows, there’s a lot of work that has to be done. “It’s really a serious undertaking that is not limited to IT, doctors or administrators,” she said. While there are many RHIOs that are doing really well in different areas, Thielst said there is no RHIO that has strength in all aspects. “It’s too early, but we’re heading in the right direction,” she said.

If there is one theme that runs across the whole guidebook, it is the necessity of all participants having a common vision. “Participants need to leave their individual interest at the door and focus on the common vision,” she said.